<!--
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<!DOCTYPE html>
<html>
    <head>
        <meta http-equiv="Content-Type" content="text/html; charset=UTF-8">
        <title></title>
        <!--        <style type="text/css">
                    label { display: block; margin: 5px 0 0 0; width: 120px; float: left; }

                </style>-->
    </head>
    <body>
       <div id="content">
                
                
           <div id="form" style="margin: 300px 0 0 0;">		
			  <form>
			  <fieldset>
                              <legend style="color: green; font-weight: 100;">Loan Application Details</legend>
         
                       
                              <table border="0" cellpadding="0" cellspacing="0">
            <tr> 
          
    <td style="color: lightslategray; font-size: 12px;">Document Number:</td>
    <td><input type="text" size="20" name="borrowerid" /></td>
  
    <td style="color: lightslategray; font-size: 12px;">Application Number: </td>
    <td><input type="text" size="20" name="fname"/></td>
    
    <td style="color: lightslategray; font-size: 12px;"> Application Date: </td>
     <td><input type="text" size="20" name="mname" /></td>
    </tr>
    <tr>
     <td style="color: lightslategray; font-size: 12px;"> Loan Type: </td>
     <td>
         <select>
             <option></option>
             <option>Loan</option>
             <option>Renew</option>
     </select>
     </td>
    </tr>
    </table>
    
                  
        
        <div class="sad" style="color: lightslategray; font-size: 12px; margin: 20px 0 0 0;" >
  
          <div><label for="a">Borrower ID Number:</label><input id="a" name="x"></div>
          <div><label for="b">Borrower Name:</label><input id="b" value="First Name" name="fname"><input id="b" value="Middle Name" name="y"><input id="b" value="Last Name" name="y"></div> 
          <div><label for="c">Current Address:</label><input id="c" value="Street Address" name="streetadd">
              <input id="b" value="Barangay" name="barangay"><input id="b" value="City or Municipality" name="cityofmuni">
              <input id="b" value="Province" name="province"></div>
          <div><label for="d">Area Code:</label>
              <select>
             <option></option>
             <option>SNC01</option>
             <option>SNC02</option>
     </select>
              </div>
          <div><label for="a">Loan Classification:</label>
              <select>
             <option></option>
             <option>100</option>
             <option>60</option>
             <option>30</option>
     </select>
          <div><label for="b">Loan Term:</label>
              <select>
             <option></option>
             <option>30 </option>
             <option>60 </option>
             <option>90 </option>
             <option>100 </option>
     </select>
          <div><label for="c">Amount applied:</label><input id="c" name="x"></div>
         
          
        </div>
        
                          </fieldset>
	                  </form>
		</div>
                
                <div id="preloan" style="color: lightslategray; font-size: 12px; margin: 20px 0 0 0; width: 270px; float: left;">
                    <fieldset>
           <legend style="color: green; font-family: monospace; font-weight: 100;">Previous Loan</legend>
          
           <div><label for="a">Account No.</label><input id="a" size="15" name="accountnumber"></div>
          <div><label for="b">PN Amount </label><input id="b" size="15" name="pnamount"></div> 
          <div><label for="c">Loan Class </label><input id="c" size="15" name="loanclass"></div>
          <div><label for="d">Loan Type </label><input id="d" size="15" name="loantype"></div>
          <div><label for="a">Loan Term </label><input id="a" size="15" name="loanterm"></div>
          <div><label for="b">Loan Balance </label><input id="b" size="15" name="loanbalance"></div> 
          <div><label for="c">Date of Release </label><input id="c" size="15" name="dateofrelease"></div>
          <div><label for="a">Loan No. </label><input id="a" size="15" name="loanno"></div>
          <div><label for="b">Days Left </label><input id="b" size="15" name="daysleft"></div> 
        
                    </fieldset>
                
                </div>
                
                
                   <div id="preloan" style="color: lightslategray; font-size: 12px; margin: 19px 0 0 0; width: 680px; float: right;">
                    <fieldset>
           <legend style="color: green; font-family: monospace; font-weight: 100;">(To be filled up by Branch Secretary after loan is pre-approved)</legend>
          
           <div><label for="a">Cobborrower Name </label><input id="a" name="accountnumber"> <input id="a" name="accountnumber"> <input id="a" name="accountnumber"></div>
           <div><label for="b">Coborrower Address </label><input id="b" size="15" name="pnamount"> <input id="a" name="accountnumber"> <input id="a" size="15" name="accountnumber"> <input id="a" size="15" name="accountnumber"></div> 
          <div><label for="c">Business Type </label><input id="c"  name="loanclass"></div>
          <div><label for="d">Amount of Stocks </label><input id="d" name="loantype"></div>
          <div><label for="a">Daily Average </label><input id="a" name="loanterm"></div>
          <div><label for="b">Credit Rating </label><input id="b" name="loanbalance"></div> 
          <div><label for="c">Types of Collaterals </label><input id="c" name="dateofrelease"></div>
          <div><label for="a">Appliances </label><input id="a" name="loanno"></div>
          <div><label for="b">Motor Vehicle </label><input id="b" name="daysleft"></div> 
          <div><label for="b">Passenger Vehicle </label><input id="b" name="loanbalance"></div> 
          <div><label for="c">Passenger Tricycle </label><input id="c" name="dateofrelease"></div>
          <div><label for="a">House of Lot </label><input id="a" name="loanno"></div>
          <div><label for="b">Land Title </label><input id="b" name="daysleft"></div> 
          <div><label for="b">Amount Requested </label><input id="b" name="daysleft"></div> 
                               
                    
                    </fieldset>
                
                </div>
                
       </div>
                             
          
    </body>
</html>
